Effective communication between clinicians may be a crucial component of safe care. High-quality communication may be especially critical during care transitions between clinicians (handoffs). In this two-year quasi-experimental Quality Improvement project, we will use simulation learning to evaluate and improve communication and coordination between anesthesia providers and nurses as care is transitioned from the operating room to the post-anesthesia care unit (PACU). Using a multiple baseline, staggered entry, prospective cohort design with repeated measures, a new training intervention (Simulation Training for Rapid Assessment and Improved Teamwork - STRAIT) will be introduced into two PACUs. The primary hypothesis is that simulation-based communication skills training of PACU personnel will significantly improve the quality of handoffs. We also hypothesize that such training will enhance the PACU's culture of communication and quality of care. Our three Aims are to: 1) develop a training intervention (STRAIT) for PACU handoffs; 2) determine if STRAIT improves PACU handoff quality; and 3) study the impact of a single focused training intervention on the PACU's communication culture and outcomes. After an initial two-month baseline of observations of actual patient handoffs, clinicians from one PACU will receive STRAIT. Training in the second PACU will begin nine months later. The results of daily field observations will be fed back to clinicians during the intervention. STRAIT will consist of preparatory web didactics and experiential learning using both manikins and standardized clinicians. Prior to every training session, clinicians will perform a videotaped simulated handoff. Individual clinician's simulated handoff performance will be compared before and after their training (Aim 1) on four dimensions of handoff effectiveness: information transfer; use of best evidence handoff strategies; interpersonal skills; and team behaviors. Clinicians will also rate their own handoffs. For Aim 2, trained observers will apply abbreviated metrics of the same effectiveness dimensions to actual PACU handoffs pre- versus post-STRAIT. For Aim 3, we will assess pre- versus post-training differences in clinician responses to a communication culture survey as well as for selected PACU-specific process and outcome measures. Successful demonstration of STRAIT'S effectiveness will lead to rapid dissemination of the methods to other clinical handoff situations. [unreadable] [unreadable] [unreadable]